Papain Induced Occupational Asthma with Kiwi and Fig Allergy

Abstract

Papain is a proteolytic enzyme which is widely used in food industry, pharmaceuticals, and cosmetics. Occupational and non-occupational papain allergies have previously been documented; however, there are limited publications about papain allergy with its relative fruit allergy. Here, we present a case of occupational, IgE-mediated papain allergy with kiwi fruit and fig fruit allergy. A 53-year-old man suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant where papain is often used as a meat tenderizer. He began to experience symptoms of chest tightness, shortness of breath and wheezing shortly after starting work 5 years ago. Furthermore, he experienced several episodes of oral itching, and tongue and oropharyngeal angioedema after injestion of kiwi fruit and fig fruit. The patient had a lifelong history of allergic conjunctivitis, allergic rhinitis, and childhood asthma. Specific IgE was positive to kiwi fruit, papain and chymopapain (2.95 kUA/L, >100 kUA/L, and 95.0 kUA/L, respectively). Similar bands at 10-15 kDa in blotting with papain and kiwi fruit extracts were found. This patient showed a potential association between papain allergy and sensitization to kiwi fruit. We also reviewed 13 patients with papain allergy published in the literature, with 85% (11/13) of the patients sensitized through the respiratory tract, and 40% (4/11) having atopy. Further studies should focus on the determination of cross-reactive allergens between papain and its fruit relatives, and the prevalence of food allergy in patients with papain allergy should be investigated in a relatively large cohort.

Is exposure to pollen a risk factor for moderate and severe asthma exacerbations?

“…To our best knowledge, this is the first systematic review and meta‐analysis to comprehensively summarize the relationships between pollen exposure and asthma exacerbation, as assessed through various respiratory outcomes with strict methodological concerns. The existing literature collected in a recent review of the respiratory health burden attributable to short‐term exposure to pollen had already suggested evidence of an association between outdoor pollen concentrations and most of the asthma outcomes we considered, especially in people with pre‐existing respiratory diseases 3–139 . Our overall meta‐analysis, subgroup analysis, and publication bias assessment confirm that a relationship between pollen exposure and asthma exacerbation exists but this require additional research due to its heterogeneity.…”

“…The cross-reactive allergens include profilins, lipid transfer proteins, and high-molecular-weight allergens and/or glycoallergens. 45 TA B L E 1 Severe asthma exacerbation related to total pollen exposure in the general population (adjusted results). Horticulturists and fruit tree workers can develop occupational respiratory allergic diseases (rhinoconjunctivitis and asthma).…”

“…Immunoglobulin E (IgE) reactivity to multiple food allergens, birch, and mugwort pollens, as well as a variety of plant profilins has been demonstrated. The cross‐reactive allergens include profilins, lipid transfer proteins, and high‐molecular‐weight allergens and/or glycoallergens 45 …”

The Pioneer Transcription Factor Foxa2 Modulates T Helper Differentiation to Reduce Mouse Allergic Airway Disease

“…Comparison between control populations showed that Foxa2 is ~6-fold more highly expressed in lung epithelial cells than in lung T-cells (Figure S3A). To induce AAD, we used papain as allergen, which induces allergic airway inflammation by initiating a Th2 immune response and is linked to occupational and non-occupational asthma and allergy in humans (29,35,(39)(40)(41)(42)(43)(44)(45). We administered intranasal papain in PBS to Foxa2cKO (Foxa2f/fCD4Cre+) and control (Foxa2f/ fCD4Cre neg ) mice on day 0 and day 7 and sacrificed mice on day 10, treating with PBS alone at the same time points as negative control (Figure S1A).…”

Unusual allergen in a butcher with respiratory symptoms

“…While the risk of developing occupational allergic asthma is considered very high for bakers, this risk is considerably lower for butchers [ 2 , 9 ]. In the scientific literature, there are only case reports of butchers with occupational asthma [ 3 , 4 , 5 , 7 , 14 ] or contact dermatitis [ 1 , 16 ] caused by meat proteins, various vegetable spices, the red dye carmine, or the enzyme papain, which is used as a meat tenderizer.…”